P927: ACTUAL USAGE OF CURRENT SYSTEMIC TREATMENTS AND INFLUENCE OF KEY DRIVERS FOR MULTIPLE MYELOMA IN THE FIRST 2 LINES OF THERAPY. DATA FROM REAL-WORLD STUDY IN EU5 COUNTRIES.
Authors: Nicolas Blin, Siegfried Ertl, Elodie Schneider, Christine Mai
Journal: HemaSphere (2023)

Topic: 14. Myeloma and other monoclonal gammopathies - Clinical Background: The therapeutic landscape in multiple myeloma (MM) has changed dramatically in recent years. Pharmacological innovation resulted in increased complexity of treatment choice. Discrepancies within Europe are observed regarding reimbursement and availability of MM drugs. Real practice differs from clinical trial designs and needs to be investigated against official guidelines. Aims: Identify treatment patterns in MM in EU5 countries based on real-world patient data. Methods: Anonymous patient charts, provided by onco-haematologists treating patients with MM in EU5 countries: France (FR), Germany (DE), Spain (ES), Italy (IT) and UK were analyzed. A total of 4,851 unique patient charts were included in the analysis, filled by 430 Doctors from October to December 2022. The analysis focused on the first 2 lines of therapy for MM: 1,279 first line (1L) patients, 441 receiving induction treatment prior to autologous stem cell transplantation (SCT) and 838 patients non eligible for intensive treatment, + 1,208 second line (2L) patients. D= daratumumab; V=bortezomib; T=thalidomide; d= dexamethasone; R=lenalidomide; M= melphalan; p= prednisone; K=carfilzomib Results: Median age (in years) was 59 in SCT eligible and 74 in SCT ineligible populations. No difference in patient age was observed between countries. ECOG score at treatment initiation was 0-1 in 91% of SCT eligible patients and 66% in the SCT ineligible population. ISS stage was II in 25% and III in 61% of SCT patients vs. 32% and 57% of SCT ineligible patients. Cytogenetic profile revealed high risk in 34% in patients fit for SCT and 14% in those receiving less intensive treatment. In accordance with EHA-ESMO 2021 clinical practice guidelines, D-VTd was the most frequently used combination in SCT eligible patients (FR:23%, DE:30%, IT:29%, ES:14%, UK:60%). VRd was less frequently used except in ES (49% vs. 14% for D-VTd). D-VRd was the third most frequently prescribed regimen in 1L SCT eligible patients. Frequencies ranged from 46% in FR, to 1% & 2% in DE and the UK, where low use is likely due to lack of reimbursement of quadruplet therapy, and absence of phase III comparative data vs D-VTd. Surprisingly, peripheral neuropathy did not appear to be a key driver for the use of thalidomide vs. lenalidomide (5% grade I peripheral neuropathy in the D-VTd group vs. 0% in the D-VRd group). Similarly, no link was seen between prognostic markers and combination chosen (39% of patients with high-risk cytogenetics in D-VTd group vs 41% in D-VRd group). In 1L SCT ineligible patients, DRd was the most frequently used regimen in FR: 43%, DE: 30%, IT:19%, but not in ES: 13% or the UK: 3%. In these countries, D-VMP was the most used combination in ES: 30% (<10% of patients in the FR, DE, IT, UK), while Rd was most frequently used in the UK: 30%. In 2L patients, the most frequently used combinations were DRd in FR, DE & IT (30%, 20% and 17% of patients respectively), KRd in ES (15%) and DVd in the UK (28%), the major driver being the regimen received in 1L. Summary/Conclusion: This real-world study demonstrates that regimens recommended in the latest 2021 EHA-ESMO guidelines are the most frequently used in both 1L and 2L in most EU5 countries. However, discrepancies do exist between countries regarding the use of regimens that are not fully reimbursed (i.e., D-VRd), the use of DRd in 1L, and KRd/DVd in 2L. No major drivers of treatment choice, based on disease risk or treatment efficacy could be identified vs. published data. These differences are probably more dependent on physician prescribing habits and local recommendations. Keywords: Multiple myeloma, relapsed/refractory, Real world data, Regimen